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NHS review: Where did the “13,000 deaths” figure come from?

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There is a lot of rage in Westminster today (beyond the everyday anger exhibited by some of its inhabitants that Parliament contains other people who disagree with them) about the 13,000 deaths figure that has been bandied around ahead of the publication of the Keogh review. It’s worth noting firstly that Jeremy Hunt did not refer to this 13,000 in his statement to the Commons, but the figure made its way into the newspapers before the report’s publication. He did say that ‘no statistics are perfect, but mortality rates suggest that since 2005, thousands more people may have died than would normally be expected at the 14 trusts reviewed by Sir Bruce’.

It isn’t a made-up figure, but neither is it a list of 13,000 people who have definitely ended up in a mortuary as a result of the failings at the 14 hospitals examined by Keogh. It is in fact a calculation by Professor Sir Brian Jarman of Imperial College. Jarman calculates that had the hospitals had average death rates, 13,000 deaths could have been avoided in that period (you can download his working here). That is very different to 13,000 avoidable deaths that definitely occurred. The Keogh report sounds a note of caution about hospital standardised mortality ratios and summary hospital-level mortality indicators:

‘However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths. Robert Francis himself said, “it is in my view misleading and a potential misuse of the figures to extrapolate from them a conclusion that any particular number, or range of numbers of deaths were caused or contributed to by inadequate care”.’

That’s not to say that the Keogh report doesn’t make extremely difficult reading for the trusts involved. Whatever you can take from mortality figures, the hospitals were failing to do so: Keogh said few hospitals had a good understanding of why their rates were high. ‘This contributed to them having weak or incomplete strategies for improving performance,’ the report said.

More clinically relevant, perhaps, is the number of ‘never events’, which are serious incidents such as surgery on the wrong body part, the wrong drugs being administered, or tools being left inside a patient after an operation. Keogh found that all but two of the trusts had ‘never events’ which the report said was ‘extremely concerning’. If a never event should never have happened, it is reasonable to assume that it should at least never happen again in a hospital. But the review said:

‘Of even more concern is that a number had multiple never events relating to similar themes, such as retained foreign objects post-operation, where we were not assure that lessons had previously been learnt in response.’